Early results of one study suggests aura increases the risk for major adverse cerebrovascular and CV events (MACE) in those with migraine, and that this risk is particularly high in men.
The findings were presented on June 15, 2024, at the American Headache Society (AHS) 2024 annual meeting.
The extent to which migraine increases the risk for stroke CV outcomes has not been extensively studied.
Using Mayo Clinic electronic health records, which covers all three sites (Florida, Minnesota, and Arizona), researchers identified individuals with migraine using diagnostic codes. They also data on sex, race, and the presence of aura.
They investigated whether a history of MACE risk factors — including atrial fibrillation, diabetes, hyperlipidemia, hypertension, and tobacco use — affected risk and the potential interaction of aura with these risk factors.
MACE events included cerebral infarction, intracerebral hemorrhage, and acute myocardial infarction.
The analysis included 130,126 participants (80% women, 95% White individuals). Of these, 6% experienced a MACE event, and 94% did not.
"We confirmed that aura does increase the risk for a MACE event, and all of the known risk factors that we included were also significant," said Dumkrieger.
Odds ratios (ORs) were 3.82 for atrial fibrillation, 3.11 for hypertension, and 3.06 for hyperlipidemia.
It was surprising, said Dumkrieger, that male sex was tied to an increased risk for a MACE event (OR, 1.40). This is not something that was known before.
The link between migraine and ischemic stroke, particularly with aura, was stronger in women — particularly young women.
Investigators also found an interaction between male sex and aura, when it comes to MACE outcomes, said Dumkrieger. "Males in general are at higher risk, and people with aura are at higher risk. Males with aura are also at higher risk, but maybe not as much as you would think they would be. It's not a purely additive thing. This is something we need to look into more," she said.
The study also revealed an interaction between aura and hypertension as well as aura and tobacco use, but here too, it was not an additive risk, said Dumkrieger. However, she added, the presence of aura does not moderate the risk for hyperlipidemia, diabetes, or atrial fibrillation.
The research also showed a significant interaction between male sex and Black race which was additive. "There's apparently increased risk if you are male and Black or African American that's greater than what you would expect.
https://www.medscape.com/viewarticle/new-insight-cvd-stroke-risk-migraine-2024a1000buu
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